Nontraumatic Cervical Myelopathy: Pathologies, Surgical Techniques, and Nuances


Eyal Itshayek (Editor)
Director, Spine Unit, Department of Neurosurgery, Rabin Medical Center, Petah Tikva, Israel

Series: Neuroscience Research Progress
BISAC: MED057000

The earliest human known to have the capability of walking erect on two legs is Sahelanphropus, who lived 6 million years ago. The ability to stand erect led to required extensive changes in the human skeleton, including significant changes in the cervical spine. In modern humans, the cervical spine holds the head upright and gives it great mobility. The combination of great mobility in this spinal segment combined with the requirement that it carry significant weight makes the cervical spine susceptible to a wide variety of pathologies. The cervical spine not only supports the head upright, but acts as a channel for the full set of neural elements connecting the brain with all near and distant parts of the body; thus, pathologies involving the spinal column in this segment directly affect the cervical spinal cord and exiting nerve roots.

Today, excellence in spine surgery requires a thorough understanding of spinal anatomy, relevant neurology, and biomechanics, as well as skilled use of a variety of surgical techniques. The surgeon must master the ability to effectively select from a wide and constantly changing variety of alternative instrumentations and surgical approaches. In addition, the trend towards reducing the invasiveness of surgical procedures has led to the use of smaller and smaller tools and smaller surgical incisions with more limited views of the relevant anatomy. As a result of the rapid pace of change, the choice of an optimal technique in any given situation is increasingly complex.

In this book, we begin with a basic review of anatomy, neurology, neurophysiology, and biomechanics. We also discuss clinical and radiological assessment required for a differential diagnosis, and present a thorough discussion of the importance of sagittal alignment of the spine and the utility of gait analysis. We proceed with a thorough discussion of nontraumatic pathologies causing cervical myelopathy, beginning with the craniocervical junction down through the subaxial spine, in pediatric and adult populations. This discussion includes steps in the differential diagnosis for specific pathologies, surgical techniques and nuances, radiation-based treatment alternatives, and special topics ranging from the use of stem cells to robotics and endoscopic surgery.

We have attempted to provide both fundamental and state-of-the-art knowledge and to share the rich experience of some of the leading spine surgeons worldwide, with the aim of enabling surgeons at all levels to advance their own capabilities for performing safe and successful procedures in this area of complex anatomy.
(Imprint: Nova Medicine and Health)

Table of Contents

Table of Contents



Chapter 1. Descriptive Anatomy and Embryology of the Cervical Spine
(David Felzensztein, Steven Jackson and Eyal Itshayek, Resident, Spine Unit, Dept of Neurosurgery, Rabin Medical Center, Petah Tikva, Israel, and others)

Chapter 2. Biomechanics of the Cervical Spine
(Vikram Chakravarthy, William J. Kemp and Edward C. Benzel, Resident Physician, Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, US, and others)

Chapter 3. Differential Diagnosis of the Cervical Spine: Clinical Evaluation
(Marc Gotkine, Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel)

Chapter 4. Electrophysiological Assessment in Cervical Spine Disorders
(Marc Gotkine, Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel)

Chapter 5. Radiological Evaluation of the Non-Traumatic Cervical Spine
(Rut Eliahou and Asaf Honig, Attending Physician, Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, and others)

Chapter 6. Sagittal Alignment of the Cervical Spine
(Andrea Redaelli, Alvin Pun and Pedro Berjano, Consultant, GSpine, Spine Surgery Division, IRCCS Instituto Ortopedico Galeazzi, Milan, Italy)

Chapter 7. Utility of Gait Analysis in Patients with Cervical Myelopathy
(Ram Hadass and Isador H. Lieberman, Director of Research, Texas Back Institute, Plano, TX, US)

Chapter 8. Timing of the Diagnosis in Degenerative Cervical Myelopathy
(Gilad Regev, John N. Jabang, Khalil Salame, Khalil Salame, Lador Ran and Zvi Lidar, Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel)

Chapter 9. Indications and Timing of Surgery in Degenerative Cervical Myelopathy
(Omar Khan, Jetan H. Dadhiwala, Muhammad A. Akbar, Michael Fehlings, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada, and others)

Chapter 10. Stem Cell Therapy in the Management of Cervical Degenerative Disease
(Ethan J. Cottrill, A. Karim Ahmed, Zach Pennington, Timothy F. Witham, Nicholas Theodore, Department of Neurosurgery, Johns Hopkins University, Baltimore, MD, US, and others)

Chapter 11. C1-2 Instability and Degenerative Cervical Myelopathy
(Kanwaljeet Garg and Shashank Kale, Assistant Professor of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India, and others)

Chapter 12. Cervical Decompression and Fusion through an Anterior Approach
(Nikolay Gabrovsky, Head, Department of Neurosurgery, University Hospital Pirogov, Sofia, Bulgaria)

Chapter 13. Posterior Cervical Decompression with Cervical Laminoplasty
(Granit Molliqaj and Enrico Tessitore, Department of Neurosurgery, University Hospital of Genèva, Gèneva, Switzerland)

Chapter 14. Posterior Approaches to the Cervical Spine Cervical Decompression and Fusion through an Anterior Approach
(Marcel Ivanov MD, PhD, Ion Poeata and Prihank Sinha, Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, England)

Chapter 15. Tumors of the Craniocervical Junction
(Crystal Adams, MD, and Walter C. Jean, Resident Physician, Department of Neurosurgery, George Washington University, Washington, DC, US, and others)

Chapter 16. Surgical Approaches to the Craniocervical Junction for Neoplastic Lesions
(Alon Orlev, MD, Sagi Harnof, MD, Daniel M. Sciubba, MD, and Rafael J Tamargo, MD, Attending Physician, Department of Neurosurgery, Rabin Medical Center, Petah Tiqva, Israel, and others)

Chapter 17. Surgical Approaches in Metastatic Disease Involving the Craniocervical Junction
(A. Karim Ahmed, Andrew Schilling, Zach Pennington, Ian Suk and Nicholas Theodore, MD, Medical Student, Johns Hopkins Medical School, Baltimore, MD, US, and others)

Chapter 18. Intradural Extramedullary Spinal Cord Tumors
(Marcel Ivanov and Prihank Sinha, Department of Neurosurgery, Sheffield Teaching Hospitals, Sheffield, England)

Chapter 19. Intradural Intramedullary Spinal Cord Tumors
(Sanjay Konakondla, Sean M. Barber, Johathan Nakhla, Jared S. Fridley and Attending Physician, Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School of Brown University, Providence, RI, US, and others)

Chapter 20. En Bloc Resection of Primary Bone Tumors of the Cervical Spine: Surgical Considerations and Avoiding Complications
(Peter Pal Varga and Balazs Szöllösi, Chairman and CEO, National Center for Spinal Disorders, Budapest, Hungary, and others)

Chapter 21. Surgical Management of Spinal Metastases Involving the Cervical Spine
(Vanessa Hubertus, Julia Sophie Onken and Peter Vajkoczy, Department of Neurosurgery, Charité University Medicine, Berlin, Germany, and others)

Chapter 22. Advanced Radiotherapy for the Primary Tumors in Cervical Spine
(Ung-Kyu Chang, Director, Department of Neurosurgery, Korea Cancer Center Hospital, Seoul, South Korea)

Chapter 23. Advanced Radiotherapy for Metastatic Disease of the Cervical Spine
(Yoshiya Yamada, Virgina W. Osborn, Anna Lee, Ori Barzilai, Ilya Laufer and Mark H. Bilsky, Attending Radiation Oncologist, Memorial Sloan Kettering Cancer Center, New York, NY, US)

Chapter 24. Stereotactic Radiosurgery for the Management of Intradural Neoplasms of the Cervical Spine
(Hanna N. Algattas, John C. Flickinger and Peter Carlos Gerszten, Attending Physician, Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, US)

Chapter 25. Cervical Kyphosis and Scoliosis
(Andrzej Maciejczak, Professor and Head, Department of Neurosurgery, Tarnów, Poland, and others)

Chapter 26. Vertebral Osteomyelitis, Discitis, and Epidural Abscess of the Cervical Spine in Intravenous Drug Users
(Domhnall Street and John Street, Kinesiology student, research assistant, Division of the Spine, Department of Orthopedics, University of British Columbia, Vancouver, BC, Canada, and others)

Chapter 27. Cervical Myelopathy of Vascular Origin
(Iddo Paldor, Cezar J. Mizrahi, Josh Schroeder, Eyal Itshayek and José E. Cohen, Departments of Neurosurgery, Orthopedic Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, and others)

Chapter 28. Cervical Myelopathy in Pediatric Patients
(Gustavo Rajz, Neelan Marianayagam, Daniel Barsky, Yosef Schechter, Eli Ben-David

Chapter 29. The Cervical Spine in Achondroplasia
(Royce W. Woodroffe and Arnold H. Menezes, Resident Department of Neurosurgery, University of Iowa Hospital and Clinics, Iowa City, IA, US, and others)

Chapter 30. Tuberculosis of the Cervical Spine
(Johannes Davis and Sanesh Miseer, Spine Service, Department of Orthopaedic Surgery, Tygerberg Academic Hospital and Stellenbosch University, Western Cape, South Africa)

Chapter 31. The Role of Sagittal Alignment in Surgery for Degenerative Cervical Myelopathy
(Ethan Cottrill, Chau Vo, Sara Johnson, Bowen Jian, Timothy F. Witham and Nicholas Theodore, Department of Neurosurgery, Johns Hopkins Hospitals, Baltimore, MD, US, and others)

Chapter 32. Fusion Techniques for C1–C2 Instability
(Megan M. Jack, Moshe Levenkopf, Alon Friedlander and Paul M. Arnold, Department of Neurosurgery, University Kansas Medical Center, Kansas City, KS, US, and others)

Chapter 33. Transoral Approach for the Lesions of the Dens
(Manoj Phalak and Shashank Kale, Assistant Professor, Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India, and others)

Chapter 34. Endoscopic Endonasal Approach to the Craniocervical Junction
(Kaiyun Yang, Jenna Rebelo, Kesava Reddy and D. Sommer, Resident, Department of Neurosurgery, McMaster University, Hamilton, ON, Canada, and others)

Chapter 35. Full-Endoscopic Surgical Strategies with Anterior and Posterior Approaches
(S. Özdemir, Martin Komp, Patrick Hahn and Sebastian Ruetten, Center for Spine Surgery and Pain Therapy, Center for Orthopaedics and Traumatology, St. Elisabeth Group, Catholic Hospitals Rhein-Ruhr, Herne, Germany, and others)

Chapter 36. Anterior Cervical Discectomy and Fusion: The Controversy between Use of an Interbody Graft with Anterior Plating versus a Stand-Alone Cage
(Steve Jackson, David Felzensztein, Eilat Sapirstein, Dennis Pushkov and Eyal Itshayek, Attending Spine Surgeon, Department of Neurosurgery, Rabin Medical Center, Petah Tikva, Israel, and others)

Chapter 37. Cervical Disc Arthroplasty
(Joseph Cox and Richard Guyer, Texas Back Institute TBI, Dallas, TX, US)

Chapter 38. Robotic and Image-Guided Surgery in the Cervical Spine
(Virendra R. Desai, Saeed Sadrameli, Zain Boghani and Paul J. Holman, Chief, Spine Service, Department of Neurosurgery, Houston Methodist Hospital, Texas Medical Center, Houston, TX, US, and others)

Chapter 39. Operative Neurophysiology of the Cervical Spine
(Omer Zarchi and Cornelia Drees, Intraoperative Neurophysiology Service, Rabin Medical Center and Schneider Children’s Medical Center, Petah Tikva, Israel, and others)

Chapter 40. Surgical Complications with the Anterior Approach
(Bogdan F. Iliescu and Dabija G. Marius, Assistant Professor of Neurosurgery, Department of Neurosurgery, Prof. Dr. Nicolae Oblu Medical Center, Iaşi, Romania, and others)

Chapter 41. Surgical Complications with the Posterior Approach
(Jason Pui Yin Cheung, Paul Aarne Koljonen and Keith Dip Kei Luk, Clinical Assistant Professor, Orthopaedics and Traumatology, University of Hong Kong, Hong Kong SAR, China, and others)

Chapter 42. The Future of Cervical Myelopathy Management
(Anand H. Segar, BHB, MBChB, DPhil(Oxon), FRACS, Dhruv K.C. Goyal and Alex R. Vaccaro MD, PhD, Fellow, Orthopedic Spine Surgery, Rothman Orthopedic Institute, Thomas Jefferson University Medical Center, Philadelphia, PA, US, and others)


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